Provider Demographics
NPI:1114795697
Name:STRONG, DESTINEE SHACOLE
Entity Type:Individual
Prefix:
First Name:DESTINEE
Middle Name:SHACOLE
Last Name:STRONG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 EMERALD RD N APT D7
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:SC
Mailing Address - Zip Code:29646-3068
Mailing Address - Country:US
Mailing Address - Phone:864-854-4505
Mailing Address - Fax:
Practice Address - Street 1:310 EMERALD RD N APT D7
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:SC
Practice Address - Zip Code:29646-3068
Practice Address - Country:US
Practice Address - Phone:864-854-4505
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-14
Last Update Date:2023-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health